Provider Demographics
NPI:1033771118
Name:HARPER, GWENDOLYWN DELORES
Entity Type:Individual
Prefix:
First Name:GWENDOLYWN
Middle Name:DELORES
Last Name:HARPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CARRIAGE CT
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1883
Mailing Address - Country:US
Mailing Address - Phone:706-330-0887
Mailing Address - Fax:
Practice Address - Street 1:101 CARRIAGE CT
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1883
Practice Address - Country:US
Practice Address - Phone:706-330-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide